open access
메뉴ISSN : 0376-4672
Inadequate keratinized mucosa around dental implants can lead to more plaque accumulation, tissue inflammation, marginal recession and attachment loss. We evaluated the effects of free gingival and extracellular matrix membrane grafts performed to increase the insufficient width of keratinized tissue around dental implants in the posterior mandible. A 47-year-old female patient presented with discomfort due to swelling of the lower right second premolar area. Due to severe destruction of alveolar bone, the tooth was extracted. After 3 months, a guided bone regeneration (GBR) procedure was performed and then a dental implant was placed 6 months later. During the second-stage implant surgery, free gingival grafting was performed to increase the width of the keratinized tissue. After 12 months, a clinical evaluation was performed. A 64-year-old female patient had a missing tooth area of bilateral lower molar region with narrow zone of keratinized gingiva and horizontal alveolar bone loss. Simultaneous implant placement and GBR were performed. Five months after the first-stage implant surgery, a gingival augmentation procedure was performed with an extracellular matrix membrane graft to improve the width of the keratinized tissue in the second-stage implant surgery. After 12 months, a clinical evaluation was performed. In these two clinical cases, 12 months of follow-up, revealed that the increased width of the keratinized tissue and the deepened oral vestibule was well maintained. A patient showed a good oral hygiene status. In conclusion, increased width of keratinized tissue around dental implants could improve oral hygiene and could have positive effects on the long-term stability and survival rate of dental implants. When planning a keratinized tissue augmentation procedure, clinicians should consider patient-reported outcomes.
1. Lindhe J, Maynard Jr. G, Miller PD, et al. Consensus report. Mucogingival therapy. Annals of periodontology / the American Academy of Periodontology 1996;1:702-706.
2. Agudio G, Nieri M, Rotundo R, Cortellini P, Pini Prato G. Free gingival grafts to increase keratinized tissue: a retrospective long-term evaluation (10 to 25 years) of outcomes. Journal of periodontology 2008;79:587-594.
3. Agudio G, Nieri M, Rotundo R, Franceschi D, Cortellini P, Pini Prato G. Periodontal conditions of sites treated with gingival-augmentation surgery compared to untreated contralateral homologous sites: a 10-to 27-year long-term study. Journal of periodontology 2009;80:1399-1405.
4. Lin G-H, Chan H-L, Wang H-L. The significance of keratinized mucosa on implant health: a systematic review. Journal of periodontology 2013;84:1755-1767.
5. Wennström JL, Derks J. Is there a need for keratinized mucosa around implants to maintain health and tissue stability? Clinical Oral Implants Research 2012;23:136-146.
6. Chung DM, Oh T-J, Shotwell JL, Misch CE, Wang HL. Significance of keratinized mucosa in maintenance of dental implants with different surfaces. Journal of periodontology 2006;77:1410-1420.
7. Crespi R, Capparé P, Gherlone E. A 4-year evaluation of the peri-implant parameters of immediately loaded implants placed in fresh extraction sockets. Journal of periodontology 2010;81:1629-1634.
8. Thoma DS, Buranawat B, Hämmerle CH, Held U, Jung RE. Efficacy of soft tissue augmentation around dental implants and in partially edentulous areas: a systematic review. Journal of clinical periodontology 2014;41.
9. Nevins M, Nevins ML, Camelo M, Camelo JMB, Schupbach P, Kim DM. The clinical efficacy of DynaMatrix extracellular membrane in augmenting keratinized tissue. International Journal of Periodontics & Restorative Dentistry 2010;30.
10. Wei P-C, Laurell L, Geivelis M, Lingen MW, Maddalozzo D. Acellular dermal matrix allografts to achieve increased attached gingiva. Part 1. A clinical study. Journal of periodontology 2000;71:1297-1305.
11. Sanz M, Lorenzo R, Aranda JJ, Martin C, Orsini M. Clinical evaluation of a new collagen matrix (Mucograft prototype) to enhance the width of keratinized tissue in patients with fixed prosthetic restorations: a randomized prospective clinical trial. Journal of Clinical Periodontology 2009;36:868-876.
12. Jun C-M, Yun J-H. Three-Dimensional Bone Regeneration of Alveolar Ridge Defects Using Corticocancellous Allogeneic Block Grafts: Histologic and Immunohistochemical Analysis. The International journal of periodontics & restorative dentistry 2015;36:75-81.
13. Lang NP, Löe H. The relationship between the width of keratinized gingiva and gingival health. Journal of periodontology 1972;43:623-627.
14. Schrott AR, Jimenez M, Hwang JW, Fiorellini J, Weber HP. Five-year evaluation of the influence of keratinized mucosa on peri-implant soft-tissue health and stability around implants supporting full-arch mandibular fixed prostheses. Clinical Oral Implants Research 2009;20:1170-1177.
15. Scheyer ET, Sanz M, Dibart S, et al. Periodontal soft tissue non-root coverage procedures: A consensus report from the AAP Regeneration Workshop. Journal of periodontology 2015;86:S73-S76.
16. Souza AB, Tormena M, Matarazzo F, Araíjo MG. The influence of peri-implant keratinized mucosa on brushing discomfort and peri-implant tissue health. Clinical oral implants research 2015.
17. Renvert S, Quirynen M. Risk indicators for periimplantitis. A narrative review. Clinical oral implants research 2015;26:15-44.
18. Orsini M, Orsini G, Benlloch D, Aranda JJ, Lázaro P, Sanz M. Esthetic and dimensional evaluation of free connective tissue grafts in prosthetically treated patients: a 1-year clinical study. Journal of periodontology 2004;75:470-477.
19. Kim DM, Neiva R. Periodontal soft tissue non-root coverage procedures: A systematic review from the AAP regeneration workshop. Journal of periodontology 2015;86:S56-S72.
20. Lorenzo R, García V, Orsini M, Martin C, Sanz M. Clinical efficacy of a xenogeneic collagen matrix in augmenting keratinized mucosa around implants: a randomized controlled prospective clinical trial. Clinical Oral Implants Research 2012;23:316-324.